<div class="fitem">
    <label>Id:</label>
    <input name="id" class="easyui-validatebox" readonly="readonly" />
</div>
<div class="fitem">
    <label>Embassy:</label>
    <input name="embassy" class="easyui-validatebox" required="true" />
</div>
<div class="fitem">
    <label>Address :</label>
    <input name="address" class="easyui-validatebox" />
</div>
<div class="fitem">
    <label>Phone:</label>
    <input id="phone" name="phone" style="width:200px" />
</div>

<div class="fitem">
    <label>Fax:</label>
    <input name="fax" class="easyui-validatebox" />
</div>
<div class="fitem">
    <label>Requirement Documents:</label>
    <textarea name="requirement" style="width: 70%; height: 100px; padding: 0;"></textarea>
</div>
<div class="fitem">
    <label>Notes:</label>
    <textarea name="notes" style="width: 70%; height: 100px; padding: 0;"></textarea>
</div>
<div class="fitem">
    <label>Visa Prices:</label>
    <textarea name="visaprices" style="width: 70%; height: 100px; padding: 0;"></textarea>
</div>